Pain can adversely affect patients in many different ways. It can keep the patient from being active, sleeping well, enjoying family and friends, and from eating. Pain can make the patient feel afraid or depressed and prevent full participation in general rehabilitation programs and may even slow recovery.
Pain serves the important biological function of signaling the presence of damage or disease within the body and is often accompanied by inflammation (redness, swelling, and/or burning). There are two categories of pain: acute pain and neuropathic pain. Acute pain refers to pain experienced when tissue is being damaged or is damaged. Acute pain serves at least two physiologically advantageous purposes. First, it warns of dangerous environmental stimuli (such as hot or sharp objects) by triggering reflexive responses that end contact with the dangerous stimuli. Second, if reflexive responses do not avoid dangerous environmental stimuli effectively, or tissue injury or infection otherwise results, acute pain facilitates recuperative behaviors. For example, acute pain associated with an injury or infection encourages an organism to protect the compromised area from further insult or use while the injury or infection heals. Once the dangerous environmental stimulus is removed, or the injury or infection has resolved, acute pain, having served its physiological purpose, ends. As contrasted to acute pain, in general, neuropathic pain serves no beneficial purpose. Neuropathic pain results when pain associated with an injury or infection continues in an area once the injury or infection has resolved.
There are many painful diseases or conditions that require proper pain and/or inflammation control, including but not limited to a spinal disc herniation (i.e., sciatica), lower back pain, lower extremity pain, upper extremity pain, cancer, tissue pain and pain associated with injury or repair of cervical, thoracic, and/or lumbar vertebrae or intervertebral discs, tendons, ligaments, muscles, spondilothesis, stenosis, discogenic back pain, or the like.
Many of the above condition require surgical treatment to try to alleviate or control the pain. For example, an intervertebral disc herniation is a painful condition that may occur in any of the 33 discs of the spine but herniations in the lumbar and the cervical spine are most common. Disc herniations in the cervical spine may cause radiating pain and muscle dysfunction in the arm, which is generally referred to as cervical rhizopathy. While disc herniations in the lumbar spine may induce radiating pain and muscle dysfunction in the leg, which is generally referred to as sciatica. Treatments for intervertebral disc herniations include open or mini-open surgery, using very small opening incisions or percutaneously, utilizing specially designed instruments and radiographic techniques to target the pain generator or area that is involved in the painful condition.
Unfortunately, particularly with pain generators in the spine, the cause for the pain may be difficult to diagnose, as there are numerous structures containing nociceptors and often the pain radiates throughout the body. To complicate matters for the practitioner, the vertebrae of the spine look very similar and are often no more than an inch tall with only a small separation between their bony structures. Sometimes, particularly when the spine is injured or abnormal, it may be difficult to locate the injured or abnormal vertebrae involved in causing the pain. Often times the practitioner will take additional steps such as taking several X-rays, MRIs, CAT scans, and counting the number of vertebrae to ensure the right vertebra is being treated. To diagnose a pain generator from a spinal disc, for example, the practitioner may perform an invasive discography, where a needle is inserted into a disc puncturing the annulus of the disc which may increase incidence of disc degeneration.
In spite of these additional steps, sometimes the wrong vertebra is indeed treated, which subjects the patient to additional surgeries. Other times, the test to diagnose the pain generator itself may increase the risk of disc degeneration. The patient will often feel afraid or depressed and this may prevent full participation in general rehabilitation programs and may even slow recovery. Thus, there is a need to improve the diagnosis of painful spinal diseases. There is also a need to reduce surgical errors from practitioners operating on the wrong tissue site of the spine.